Provider Demographics
NPI:1174822506
Name:CHILDS, JACQUELENE C (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELENE
Middle Name:C
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELENE
Other - Middle Name:C
Other - Last Name:TEEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:620 W GROVE ST STE 202
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4425
Practice Address - Country:US
Practice Address - Phone:870-234-7676
Practice Address - Fax:870-562-2560
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-17354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine